Antipsychotics: Do they do more harm than good?

Millions of people in the United States live with schizophrenia and other severe mental disorders. Many of these people control their symptoms with the help of antipsychotic medication, but do the side effects of antipsychotics outweigh the benefits? New research investigates.

More than 3.5 million U.S. adults (or 1.1 percent of the country’s population) are affected by schizophrenia. Additionally, it is estimated that in any given year in the U.S., around 9.8 million people develop a serious mental disorder that can majorly interfere with their lives.

It is not yet known what causes schizophrenia, but treatment options – such as antipsychotic drugs and psychosocial therapies – are available to help patients manage their symptoms. Almost 7 million people in the U.S. take antipsychotic medications to treat schizophrenia and other similar conditions.

Lately, however, some studies have suggested that antipsychotics may do more harm than good, especially in the long-term. Some researchers have raised concerns over the toxic effects of these medications, suggesting that patients may only benefit from the medication in the short-term.

These concerns have gained popularity, with some articles in mainstream media suggesting that patients with schizophrenia and mood disorders may be better off without medication.

In this context, an international team of researchers set out to examine the data behind this controversial view.

The team – led by Dr. Jeffrey Lieberman, Lawrence C. Kolb Professor and chairman of psychiatry at Columbia University College in New York – investigated the long-term effects of antipsychotic medications on the brain and behavior of people with schizophrenia, as reflected by existing research.

Benefits of antipsychotic medication far outweigh the risks

The research consisted of a meta-analysis of existing clinical studies, with a focus on the long-term effect of these medications on clinical outcomes and the patients’ brain structure.

Lieberman and team looked at clinical trials and neuroscientific data, and they found that the therapeutic benefits of antipsychotic medication far outweigh their side effects.

“The evidence from randomized clinical trials and neuroimaging studies overwhelmingly suggests that the majority of patients with schizophrenia benefit from antipsychotic treatment, both in the initial presentation of the disease and for longer-term maintenance to prevent relapse.”

Dr. Jeffrey Lieberman

“Anyone who doubts this conclusion should talk with people whose symptoms have been relieved by treatment and literally given back their lives,” Lieberman adds.

According to this latest research, delaying antipsychotic treatment or not administering medicine is linked to negative long-term patient outcomes.

“While a minority of patients who recover from an initial psychotic episode may maintain their remission without antipsychotic treatment, there is currently no clinical biomarker to identify them, and it is a very small number of patients who may fall into this subgroup,” Dr. Lieberman explains.

“Consequently, withholding treatment could be detrimental for most patients with schizophrenia.”

The new research also addresses the preclinical evidence available from rodent studies. Although some of these animal models have indicated that antipsychotic medication may sensitize the dopamine receptors and increase tolerance over time, the new study underscores the fact that there is not enough evidence to suggest that antipsychotics increase the risk of relapse.

Previous research has also shown that the use of antipsychotics may raise the risk of metabolic syndrome in patients with schizophrenia. Metabolic syndrome has, in turn, been associated with heart disease and diabetes.

However, the current study did not examine the risks and benefits of antipsychotics in relation to metabolic syndrome.

“While more research is needed to address these questions, the strong evidence supporting the benefits of antipsychotic medications should be made clear to patients and their families, while at the same time they should be used judiciously,” says Dr. Lieberman.